NPI | 1679864730 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: AK 1502) |
Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-4169) |
122300000X Dentist (Licence: WA DE 60284737) | |
Enumeration Date | 2011-04-25 |
Last Update Date | 2013-08-10 |