| NPI | 1376613414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D6627) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 6627) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2008-02-07 |