| NPI | 1972910107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02573600) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 057340) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2020-03-13 |