| NPI | 1922529585 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418087) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857645) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-10-31 |