| NPI | 1215552633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS043091) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858662) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2023-08-23 |