| NPI | 1902187644 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN19667) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15103) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401413313) | |
| 122300000X Dentist (Licence: VA 0401413313) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2012-07-25 |