| NPI | 1639517303 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-5911) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4505) |
| 122300000X Dentist (Licence: WA DE 60378600) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2014-05-05 |