| NPI | 1710040217 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 043368) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ NJ 21093) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2024-08-08 |