| NPI | 1558046920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: PA DS044067) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02970500) |
| 122300000X Dentist (Licence: PA DS044067) | |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2024-09-03 |