| NPI | 1821172628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 8724) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 18081) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |