| NPI | 1386013746 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415513) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009334) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2018-03-23 |