| NPI | 1942555610 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02583500) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 400075) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2016-01-15 |