| NPI | 1891123691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 15914) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001619) |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2019-06-13 |