| NPI | 1912054305 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 12561) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401410223) |
| 122300000X Dentist (Licence: FL 16464) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-08 |