| NPI | 1164087706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 061298-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02808800) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2022-09-09 |