| NPI | 1538473517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414112) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 25543) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2013-11-07 |