| NPI | 1497043863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MO 2002011111) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2002011111) |
| 1223P0300X Dentist Periodontics (Licence: MO 2002011111) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2011-08-09 |