| NPI | 1396151445 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 11197) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 2.011197) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2015-07-15 |