| NPI | 1700170883 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414400) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9141) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2021-05-20 |