| NPI | 1811389000 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA DS041507) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30607) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2020-01-13 |