| NPI | 1629482070 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4964) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2014018214) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2018-09-17 |