| NPI | 1144726720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 16980) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060779) |
| 122300000X Dentist (Licence: VA 0401416958) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2021-12-29 |