| NPI | 1124260104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416294) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN0014852) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2021-09-30 |