| NPI | 1154558914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4608) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS038759) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2015-09-29 |