| NPI | 1467805580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PA DS039953) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039953) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2023-02-01 |