| NPI | 1154808988 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 16552) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401416158) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2018-10-22 |