| NPI | 1881083137 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 011467) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040234) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2015-11-02 |