| NPI | 1558597187 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1000939) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037896) |
| 122300000X Dentist (Licence: VA 0401412881) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2011-01-21 |