| NPI | 1275637969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 08433) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA PERMIT40085) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2011-08-11 |