| NPI | 1053751115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 10301) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413649) |
| 122300000X Dentist (Licence: SC 8197) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2016-05-23 |