| NPI | 1699062760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001036) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15322) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2020-01-09 |