| NPI | 1891343232 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS043512) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 35673) |
| 1223G0001X Dentist General Practice (Licence: PA DS043512) | |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2024-07-03 |