| NPI | 1720391550 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 27419) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS038366) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2019-11-15 |