| NPI | 1629366919 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA pending) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA pending) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2019-05-31 |