| NPI | 1164693909 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS037382) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 3748) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2013-06-12 |