| NPI | 1629179809 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KS 60725) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 53256) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-03-31 |