| NPI | 1316200645 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD3663) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM CS00217806) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-07-21 |