| NPI | 1134715261 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418728) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WV IP2001) |
| Enumeration Date | 2020-12-13 |
| Last Update Date | 2024-08-30 |