| NPI | 1245783448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D010953) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415357) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2021-02-23 |