| NPI | 1780977926 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 055422-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22di02125000) |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2011-05-20 |