| NPI | 1225106446 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN1000938) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 20253) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1000938) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2015-04-13 |