| NPI | 1760776553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS038399) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038399) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2018-03-17 |