| NPI | 1568774263 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008414) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412912) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2012-08-21 |