| NPI | 1053460212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN16361) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 3152) |
| 122300000X Dentist (Licence: CA 63275) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-11-09 |