| NPI | 1962988790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 16532) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16532) |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2018-07-15 |