| NPI | 1225053531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 5769) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019-025879) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2015-04-07 |