| NPI | 1316171648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412287) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 10131) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2023-07-20 |