| NPI | 1063296457 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 40972) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02991500) |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2026-05-07 |