| NPI | 1548743164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416497) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7504) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2023-06-04 |