| NPI | 1174517171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 09874) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D8427) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2021-06-24 |