| NPI | 1972792356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D9379) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NV 5594) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2017-01-25 |