| NPI | 1609025311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02324800) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037365) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2020-02-17 |