| NPI | 1073850202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 7219) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.029293) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2016-02-22 |