| NPI | 1760620660 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414567) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 10530) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2020-06-16 |