| NPI | 1134968688 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI03034300) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901602311) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2026-04-24 |