| NPI | 1386179646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415762) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: VA 0402204090) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2022-07-21 |