| NPI | 1710240619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056016) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02392200) |
| Enumeration Date | 2012-06-17 |
| Last Update Date | 2012-06-17 |