| NPI | 1437818580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 000120) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61192038) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2021-12-15 |