| NPI | 1104104876 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 51) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401-411721) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |