| NPI | 1962816785 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DN00202983) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20602) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2016-09-13 |