| NPI | 1417690553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02989600) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044499) |
| Enumeration Date | 2022-04-17 |
| Last Update Date | 2024-07-01 |