| NPI | 1942753975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 22060) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040998) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2019-07-22 |