| NPI | 1194123638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN23797) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039658) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2019-12-17 |