| NPI | 1811424013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS041250) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041250) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2020-05-21 |