| NPI | 1275608671 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15169) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413273) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2014-05-06 |