| NPI | 1760864524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14519) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DR02876) |
| 1223G0001X Dentist, General Practice (Licence: PA DS041550) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2022-10-10 |