| NPI | 1073928982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30092) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040767) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2018-08-02 |