| NPI | 1578935979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022394) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040784) |
| Enumeration Date | 2015-10-24 |
| Last Update Date | 2022-10-05 |