| NPI | 1962963843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicinist (Licence: VA 0411000067) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA 44205228) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-08-21 |