| NPI | 1861028896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416244) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001924) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2020-03-21 |