| NPI | 1962758912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 10793) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 10793) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2014-10-29 |