| NPI | 1487088415 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15435) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414160) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2013-08-27 |