| NPI | 1639167422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 6117) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21520) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2017-04-12 |