| NPI | 1659627685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413903) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056154) |
| 122300000X Dentist (Licence: IL 019029221) | |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2016-10-31 |