| NPI | 1710236799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D008447) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10041) |
| 1223G0001X Dentist, General Practice (Licence: CA 61829) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2020-04-22 |