| NPI | 1659668291 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02474400) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038980) |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2016-03-30 |