| NPI | 1366987901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D14320) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041124) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2019-10-30 |