| NPI | 1487826145 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 1855555) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 19089) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2013-11-05 |