| NPI | 1114906575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1000804) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15220) |
| 122300000X Dentist (Licence: VA 0401412651) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2021-04-08 |