| NPI | 1982375713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02866900) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 13250) |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-12-18 |