| NPI | 1366721805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401413462) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MD 15223) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2021-03-08 |