| NPI | 1487809752 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10053) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: OR H5021) |
| Enumeration Date | 2008-11-29 |
| Last Update Date | 2014-07-08 |