| NPI | 1275637969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D008858) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08433) |
| 122300000X Dentist (Licence: IA PERMIT40085) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2024-09-10 |