| NPI | 1265858807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20913) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856805) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2020-05-12 |