| NPI | 1659011104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 063331) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03002900) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2023-11-20 |