| NPI | 1164631644 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 202997) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 11411) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-07-30 |