| NPI | 1194070987 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 6508) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039252) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2015-02-11 |