| NPI | 1245662253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15929) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039581) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2016-09-20 |