| NPI | 1750652624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 3984) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA ds038939) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2012-05-08 |