| NPI | 1649510025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 057354) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: NJ 22D102572800) | |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2014-09-12 |