| NPI | 1417005109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019028809) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NC 0048) |
| 1223P0300X Dentist Periodontics (Licence: WA DE9503) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-08-19 |