| NPI | 1780971960 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27859) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22di02475700) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2020-03-09 |