| NPI | 1285157487 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CT 13317) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043043) |
| 122300000X Dentist (Licence: CA 101567) | |
| 1223D0004X Dentist Dentist Anesthesiologist (Licence: PA DA031866) | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-11-22 |