| NPI | 1336612639 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 17113) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041992) |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2020-04-20 |