| NPI | 1053508622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 3786-15) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: LA 5816) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2015-08-03 |