| NPI | 1962814681 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA 040915) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS107198) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA DS040915) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2024-04-25 |