| NPI | 1871641423 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 24200) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 5272) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2010-04-14 |