| NPI | 1063763928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 8449089-9921) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NV 6366) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2015-02-03 |