| NPI | 1962566596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 052284-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22d102322600) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2013-05-21 |