| NPI | 1790262665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 11157497-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041870) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2023-07-25 |