| NPI | 1487603031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D5914) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 0021123) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-07-08 |