| NPI | 1205212792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 0257) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IA 40183) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2023-02-01 |