| NPI | 1578905931 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61052) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2013026541) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2014-01-14 |