| NPI | 1538224704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC #3566) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 012121) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2014-12-04 |