| NPI | 1578658332 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414445) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16164) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2015-02-05 |