| NPI | 1861771214 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 14462) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038033) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2014-06-09 |