| NPI | 1538646906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401416152) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416152) |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2022-08-29 |