| NPI | 1215167952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS039465) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN1855220) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2013-06-24 |