| NPI | 1619125333 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021490) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412152) |
| 122300000X Dentist (Licence: WV 3828) | |
| 122300000X Dentist (Licence: WI 1001430-15) | |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2017-04-04 |