| NPI | 1194210153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 11100) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 11100) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-09-24 |