| NPI | 1083051106 |
|---|---|
| Former Name | SHABANA AZAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 21078) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN21078) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2022-07-21 |