| NPI | 1174975619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS040931) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040931) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2016-07-08 |