| NPI | 1396055760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4275) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038510) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2024-09-30 |