| NPI | 1790001436 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000368) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415421) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2017-01-30 |