| NPI | 1780861831 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 13996) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412034) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2008-01-30 |