| NPI | 1881979128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4604) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN4214) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2022-07-21 |