| NPI | 1073714531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15957) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9258) |
| 1223G0001X Dentist, General Practice (Licence: OR D8730) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-01-27 |