| NPI | 1417030495 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 10006) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: DC 5207) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2008-10-01 |