| NPI | 1942558648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001164) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 104852) |
| 122300000X Dentist (Licence: VA 0401413748) | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2012-11-12 |