| NPI | 1972820579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 99949) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 009260) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2015-10-22 |