| NPI | 1295350163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417143) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1002152) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2022-01-12 |