| NPI | 1790169308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15989) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414906) |
| 122300000X Dentist (Licence: DC DEN1001517) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2015-07-13 |