| NPI | 1013391309 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415589) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL12641) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2017-04-24 |