| 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 |