| NPI | 1477765428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 6434) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 9154) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2016-06-21 |