| NPI | 1831180512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 047965) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI2246300) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2008-08-08 |