| NPI | 1356775761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33555) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS139515) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2022-10-24 |