| NPI | 1376160192 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042694) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS042694) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2020-10-04 |