| NPI | 1861835753 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS040062) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS040062) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02600900) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2017-07-05 |