| NPI | 1710681481 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN123685) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02936500) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2025-07-16 |