| NPI | 1740416783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS037678) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037678) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2020-01-29 |