| NPI | 1649565029 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001636) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414236) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2017-02-17 |