| NPI | 1235488842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D9856) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 4010) |
| 1223G0001X Dentist, General Practice (Licence: MD 15200) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2014-01-03 |