| NPI | 1912311879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 9070494-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9070494-8903) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2014-06-18 |