| NPI | 1790239242 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34916) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D102645200) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2019-03-30 |