| NPI | 1700565520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI03075400) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418577) |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2025-03-31 |