| NPI | 1174951578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2010016997) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57498) |
| 122300000X Dentist (Licence: KS 60675) | |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2015-03-19 |