| NPI | 1114550076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI03018100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7096) |
| 1223G0001X Dentist, General Practice (Licence: TX 38109) | |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2024-04-17 |