| NPI | 1497093652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEM5312) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: DC DEN5312) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2013-01-23 |