| NPI | 1619290798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN5995) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 12623) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2017-03-13 |