| NPI | 1508111907 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15068) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1001138) |
| Enumeration Date | 2012-07-21 |
| Last Update Date | 2014-07-10 |