| NPI | 1134454523 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9238) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0059058) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2011-10-31 |