| NPI | 1164777876 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9313) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000155) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2015-07-15 |