| NPI | 1760799845 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN100922) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412837) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2023-01-06 |