| NPI | 1497031512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 011264) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401413786) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2014-10-07 |