NPI | 1053668285 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 10902) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856100) |
Enumeration Date | 2012-08-07 |
Last Update Date | 2016-08-24 |