| NPI | 1790872588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CT 10150) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16339) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-06-16 |