| NPI | 1124471248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DRPM2173) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040940) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2020-07-03 |