| NPI | 1902964620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI22016) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 11189) |
| 122300000X Dentist (Licence: SC 9526) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2020-03-13 |