| NPI | 1336372242 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE60102399) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN-10341) |
| 122300000X Dentist (Licence: CA 61348) | |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2014-04-27 |