| NPI | 1629417654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414094) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16310) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2018-03-21 |