| NPI | 1386058253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 10180) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09094) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2015-11-03 |