| NPI | 1740563600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 11090) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413345) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2019-07-01 |