| NPI | 1720210065 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NM DD3242) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO 9856) |
| 122300000X Dentist (Licence: NM DD3242) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2012-07-06 |