| NPI | 1629351994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414277) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14996) |
| 122300000X Dentist (Licence: DC DEN1001083) | |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2015-02-01 |