| NPI | 1962988519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36112) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02725200) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2020-05-26 |