| NPI | 1770710725 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 6998) |
| Additional Taxonomies | 122300000X Dentist (Licence: SD D0962) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2013-06-28 |