| NPI | 1073997748 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA VA 0401414993) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA ds040539) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2017-03-08 |