| NPI | 1336163518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2000157357) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60059) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |