| NPI | 1225310469 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2011016319) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60856) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2015-03-03 |