| NPI | 1104176353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: LA 6275) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2026-05-26 |