| NPI | 1053467480 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401410967) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 09357) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |