| NPI | 1922395920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS038811) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1856051) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2012-07-19 |