| NPI | 1871696146 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411165) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14701) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2022-08-11 |