| NPI | 1356577829 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2011002006) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 150565) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2011-12-01 |