| NPI | 1578792735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS-091445-L) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA DH00005403) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2009-07-09 |