| NPI | 1184056855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS039765) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D102544100) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-09-12 |