| NPI | 1700860855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4671) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D101230000) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2016-06-06 |