| NPI | 1679854772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9943) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6551-15) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2013-09-23 |