| NPI | 1568019479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417274) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042444) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2022-12-01 |