| NPI | 1669689204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN5153) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 10677) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-07-08 |