| NPI | 1366603110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412171) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412171) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2021-08-25 |