| NPI | 1780816074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 10204) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58510) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2010-03-09 |