| NPI | 1487089413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414146) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16138) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2016-10-06 |