| NPI | 1396030003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 90-0809888) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414490) |
| 1223G0001X Dentist General Practice (Licence: VT 016.0078267) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-07-21 |