| NPI | 1619209582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS038946) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 58604) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2023-03-14 |