| NPI | 1639274855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS035468) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8407) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-06-09 |