| NPI | 1407082738 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 1050607) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12761) |
| 122300000X Dentist (Licence: WI WI6586-015) | |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2015-03-11 |