| NPI | 1255063251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417997) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859526) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2022-08-03 |