| NPI | 1053056739 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02910900) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02910901) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2022-06-20 |