| NPI | 1811349517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA RFD000057) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 1617) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2023-06-28 |