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 |