| NPI | 1548523764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401416485) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856036) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1856036) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-12-07 |