| NPI | 1407988710 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2006020291) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60410) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2009-12-15 |