| NPI | 1275999310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ZZ 1821493) |
| Additional Taxonomies | 122300000X Dentist (Licence: ZZ 1821496) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2016-03-22 |