| NPI | 1891094298 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8134) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 26097) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2013-09-24 |