| NPI | 1417339243 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414874) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15903) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2015-07-01 |