| NPI | 1578101630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: PA RFD000033) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34590) |
| 122300000X Dentist (Licence: VA 0401416303) | |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2022-11-09 |