| NPI | 1770932253 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 17103) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415540) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2021-01-23 |