| NPI | 1992173785 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415257) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 31387) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2018-08-06 |