| NPI | 1477039360 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS041837) |
| Additional Taxonomies | 122300000X Dentist (Licence: DE G1-0011601) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2026-05-15 |