| NPI | 1689918856 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 63072) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI02520800) |
| 1223G0001X Dentist, General Practice (Licence: CT 010877) | |
| Enumeration Date | 2012-11-12 |
| Last Update Date | 2024-02-19 |