| NPI | 1639637408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 061323) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03069000) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2025-05-05 |