| NPI | 1831420504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS038182) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NJ 22DI02390600) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2014-02-24 |