| NPI | 1578053922 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042514) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060845) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2019-11-19 |