| NPI | 1679860555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056307) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02502000) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2012-09-20 |