| NPI | 1225648322 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GU D1043) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000414) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2021-09-14 |