| NPI | 1194024869 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 17477) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414041) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2023-03-28 |