| NPI | 1770966590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NC 10401) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8480) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2016-10-04 |