| NPI | 1275824732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 17175) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037646) |
| 1223P0300X Dentist, Periodontics (Licence: NC 10938) | |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2020-01-13 |