| NPI | 1295724912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN5130) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 10569) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2012-02-09 |