| NPI | 1184000580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN23922) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856652) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2019-02-19 |