| NPI | 1588829980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 2302) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0101177) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2021-07-15 |