| NPI | 1679701387 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 08968) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3134) |
| 122300000X Dentist (Licence: NE 7029) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2012-09-24 |