| NPI | 1164410619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PR 1369) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 1369) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2008-12-19 |