| NPI | 1861649980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS037634) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA DS037634) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2018-11-19 |