| NPI | 1962798728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ DI02474500) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02474500) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2019-02-19 |