| NPI | 1659531283 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6294-015) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12521) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2013-08-06 |