| NPI | 1295347029 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02816300) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042897) |
| Enumeration Date | 2020-08-22 |
| Last Update Date | 2021-11-05 |