| NPI | 1265650741 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 4165) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 3845) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |