| NPI | 1619041076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 4250) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410681) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2016-11-16 |