| NPI | 1508313560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D010611) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415223) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2023-02-17 |