| NPI | 1871060418 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 16690) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11226) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2020-01-27 |