| NPI | 1750024642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS043884) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03057000) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2025-04-04 |