| NPI | 1407870470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK AK1081) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AK 179) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2016-07-15 |