| NPI | 1356902480 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1002121) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042290) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2020-08-26 |