| NPI | 1619284031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9894) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 9201) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1855764) | |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2015-12-08 |