| NPI | 1104081520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS027742L) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20010) |
| 1223G0001X Dentist, General Practice (Licence: NJ DI1017909) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2020-11-13 |