| NPI | 1609950518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 4924) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 2392-88) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2016-06-23 |