| NPI | 1962895706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CT 12312) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040300) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PA DS040300) | |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2021-08-31 |