| NPI | 1043790447 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022791) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02905100) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2022-06-10 |