| NPI | 1730614157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24565) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02666200) |
| Enumeration Date | 2017-04-23 |
| Last Update Date | 2019-09-18 |