| NPI | 1578753455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PA DS037282) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9403) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2013-03-06 |