| NPI | 1063845311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34618) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039669) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2021-10-05 |