| NPI | 1497354450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1002161) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17170) |
| 122300000X Dentist (Licence: VA 0401417083) | |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2020-10-21 |