| NPI | 1770571507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS039436) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 3556) |
| 122300000X Dentist (Licence: SC 4224) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2013-06-21 |