| NPI | 1417248014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 010828) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 19546) |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2015-03-06 |