| NPI | 1306282355 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9491) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: NC 8953) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2013-12-28 |