| NPI | 1619013539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 12275) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 22101) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2022-06-09 |