| NPI | 1326282617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: AZ D07703) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6627) |
| 1223P0300X Dentist, Periodontics (Licence: AZ 7703) | |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2020-12-01 |