| NPI | 1578857561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27982) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.028799) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2012-06-30 |