| NPI | 1023476199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS040697) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040697) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2017-06-29 |