| NPI | 1104246404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS040335) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040335) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2018-06-29 |