| NPI | 1104086354 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PR 3523) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN16597) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2026-05-14 |