| NPI | 1871574277 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 60259) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2004013249) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2010-11-12 |