| NPI | 1790983179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 054078) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI02408100) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2015-04-17 |