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 |