| NPI | 1982084810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 37042) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414846) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2021-12-23 |