| NPI | 1053759027 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401415121) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 4060) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2020-01-07 |