| NPI | 1265521454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS031335L) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ DI021132) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2012-02-16 |