| NPI | 1841610201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001486) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15769) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2022-12-03 |