| NPI | 1659627123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15152) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15152) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2013-11-14 |