| NPI | 1710362629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MD 16370) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414610) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2018-09-10 |