| NPI | 1063773513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DB-2024-0097) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 3094) |
| 122300000X Dentist (Licence: FL DN20525) | |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2024-09-06 |