| NPI | 1013458777 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS04387) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 061286) |
| 122300000X Dentist (Licence: MA DN1857850) | |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2022-01-28 |