| NPI | 1790078830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 14807) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60543) |
| 122300000X Dentist (Licence: ZZ 12947) | |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2013-09-09 |