| NPI | 1902094261 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PA DS035850) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds035850) |
| 1223P0700X Dentist, Prosthodontics (Licence: PA DS035850) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2011-01-06 |