| NPI | 1174546022 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2005039588) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08254) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-07-08 |