| NPI | 1922302165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010419) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855547) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2012-03-27 |