| NPI | 1386094696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS042072) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000269) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401415950) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2020-02-12 |