| NPI | 1790993616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DIO2268100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DIO2268101) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-01-04 |