| NPI | 1487738290 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 009599) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 18161) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2010-02-01 |