| NPI | 1578168555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02799700) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24576) |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2020-11-30 |