| NPI | 1912004672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: TX 30516) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019027070) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2015-05-18 |