| NPI | 1366788119 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15210) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15210) |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2022-12-01 |