| NPI | 1982893160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 8710) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 5255) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2016-11-07 |