| NPI | 1649598756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: VA 0401414402) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30023177) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2022-08-05 |