| NPI | 1811240393 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS040741) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61967) |
| 1223G0001X Dentist, General Practice (Licence: TX 28679) | |
| 1223G0001X Dentist, General Practice (Licence: WA DE60620338) | |
| Enumeration Date | 2012-10-20 |
| Last Update Date | 2017-02-08 |