| NPI | 1609226646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS040894) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61170271) |
| 122300000X Dentist (Licence: UT 12078826-9921) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2021-08-10 |