| NPI | 1861926040 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415559) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32773) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2018-05-15 |