| NPI | 1386189116 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS041117) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22385) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2017-01-23 |