| NPI | 1578870481 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MO 2009021095) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2009021095) |
| 122300000X Dentist (Licence: IL 019027682) | |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2013-07-13 |