| NPI | 1154615029 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 10556) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28724) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2016-08-15 |