| NPI | 1972026730 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA DDS-09633) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7405) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2019-10-03 |