| NPI | 1902834005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D2179) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 2413-015) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2007-11-04 |