| NPI | 1215040720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 8744) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 150586) |
| 1223G0001X Dentist, General Practice (Licence: IL 019-026310) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2011-04-08 |