| NPI | 1093969297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 60394) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2006015358) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2021-07-23 |