| NPI | 1588943484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS039072) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS039072) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2017-03-13 |