| NPI | 1912102070 |
|---|---|
| Former Name | ELIZABETH MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 6640) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 12736) |
| 122300000X Dentist (Licence: WI 6020015) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2022-07-21 |