| NPI | 1205511227 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 18502) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044064) |
| 1223P0300X Dentist, Periodontics (Licence: DC DEN2000428) | |
| 1223P0300X Dentist, Periodontics (Licence: VA 401419274) | |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2025-03-26 |