| NPI | 1588096721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 78) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: MD 78) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2013-07-30 |