| NPI | 1386010320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001561) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415002) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2016-10-27 |