| NPI | 1750642559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009094) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014545) |
| 122300000X Dentist (Licence: NC 9339) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2014-10-24 |