| NPI | 1316391758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16365) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040865) |
| 122300000X Dentist (Licence: MD 16365) | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2021-12-03 |