| NPI | 1639542079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS040662) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100170) |
| 122300000X Dentist (Licence: OH 30.24748) | |
| 1223G0001X Dentist, General Practice (Licence: WV 4191) | |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2022-09-20 |