| NPI | 1285255281 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS043425) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2951000799) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2021-11-23 |