| NPI | 1104378611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS039766) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN22308) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2019-06-03 |