| NPI | 1639315377 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN5830) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: MD 12138) |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2015-07-08 |