| NPI | 1750590139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MO 2007014478) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 054784) |
| 1223P0300X Dentist Periodontics (Licence: AZ D009315) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2016-02-12 |