| NPI | 1184739658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 60144) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 59049) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2016-10-17 |