| NPI | 1336400720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 9194) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS038916) |
| Enumeration Date | 2012-06-03 |
| Last Update Date | 2015-05-19 |