| NPI | 1043736051 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS041313) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA DS041313) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2020-10-27 |