| NPI | 1649632704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NC 13510) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: SC 9547) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2023-10-16 |