| NPI | 1265816797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 10191) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS040550) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2023-03-07 |