| NPI | 1801275086 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 11710) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040552) |
| 122300000X Dentist (Licence: MA DN1857432) | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2017-04-12 |