| NPI | 1225209463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO DEN00202712) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027116) |
| 1223P0300X Dentist, Periodontics (Licence: IL 021002491) | |
| Enumeration Date | 2008-03-16 |
| Last Update Date | 2022-01-07 |