| NPI | 1073965869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02672900) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059663-1) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2026-03-16 |