| NPI | 1003876988 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 019014427) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA 021001029) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2007-07-08 |