| NPI | 1679959753 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS042851) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415171) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2020-09-09 |