| NPI | 1356016513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012026) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D012026) |
| 122300000X Dentist (Licence: NJ 22DI02858900) | |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2024-06-25 |