| NPI | 1124544994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS041494) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 33355) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2022-07-21 |