| NPI | 1073029591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IA FAC-40179) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: IA FAC-40179) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2017-12-20 |