| NPI | 1942685722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS040306) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856583) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2015-07-22 |