| NPI | 1982055406 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 16637) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 11631) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2018-03-17 |