| NPI | 1811962525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008394) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 11678) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-04-26 |