| NPI | 1811059355 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 08884) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12134) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2019-12-30 |