| NPI | 1265512081 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA 020001-L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS020001L) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-05-23 |