| NPI | 1508395609 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 17278) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: VA 0401415684) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2021-04-07 |