| NPI | 1073244109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN30209) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601440) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2025-06-19 |