| NPI | 1639536980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS040305) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20704) |
| 122300000X Dentist (Licence: NJ 22DI02617700) | |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2017-04-01 |