| NPI | 1063701787 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN014499) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 3376) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2015-03-26 |