| NPI | 1972690824 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AL 3464) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: AL 3464) |
| 126800000X Dental Assistant (Licence: AL 3464) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2018-02-05 |