| NPI | 1396099891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS039385) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 61627) |
| 1223G0001X Dentist, General Practice (Licence: PA DS039385) | |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2023-03-20 |