| NPI | 1770625253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9838) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6005 015) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2009-05-19 |