| NPI | 1417243411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS037001) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17853) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2021-01-05 |