| NPI | 1962780882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 20387) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10457) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2016-03-08 |