| NPI | 1407945215 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D5078) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 9556) |
| 122300000X Dentist (Licence: CA 35235) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |