| NPI | 1649231077 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D5762) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D8123) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2014-04-24 |