| NPI | 1104921584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 08157) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IA 08157) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |