| NPI | 1740472588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9412) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6186-015) |
| 122300000X Dentist (Licence: VA 0401412092) | |
| 122300000X Dentist (Licence: IL 019.027454) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2020-01-15 |