| NPI | 1568619724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412103) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1000734) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2012-01-12 |