| NPI | 1184076085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 11334) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 151104) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2019-11-25 |