| NPI | 1528163631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8980) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855779) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2011-08-16 |