| NPI | 1235446642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00202111) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6234) |
| 1223G0001X Dentist, General Practice (Licence: CA 59639) | |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2013-12-30 |