| NPI | 1922167055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 10404) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 7975) |
| 1223G0001X Dentist, General Practice (Licence: AZ 7153) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2014-08-29 |