| NPI | 1215103049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: AZ D009405) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MN D11993) |
| 1223P0300X Dentist Periodontics (Licence: WA DENT.DE600002903) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2022-02-15 |