| NPI | 1588810139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412767) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 11240) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2019-08-01 |