| NPI | 1588159172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022949) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02719100) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2019-06-16 |