| NPI | 1497002687 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 10825) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 057868-1) |
| 1223G0001X Dentist General Practice (Licence: NJ 22DI02516600) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2020-11-21 |