| NPI | 1508155623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ID D444PE) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5817) |
| 122300000X Dentist (Licence: WA DE60121655) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2013-04-10 |