| NPI | 1558495531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2004026198) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60293) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-12-05 |