| NPI | 1053712992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN20560) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02550400) |
| 122300000X Dentist (Licence: FL DN20560) | |
| 122300000X Dentist (Licence: NY 058915) | |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2022-07-21 |