| NPI | 1770780900 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411946) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 14119) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2010-11-03 |