| NPI | 1245217801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 60106) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2011036173) |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2015-02-04 |