| NPI | 1366884819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 29515) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02535100) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2021-05-12 |