| NPI | 1295045490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1000982) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14598) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2012-11-27 |