| NPI | 1689654956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6527) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 8320) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2015-09-08 |