| NPI | 1205972494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA ds036472) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16676) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2013-09-17 |