| NPI | 1568699270 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2011010552) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60786) |
| 1223G0001X Dentist General Practice (Licence: NE 6843) | |
| Enumeration Date | 2009-06-20 |
| Last Update Date | 2018-04-27 |