| NPI | 1124631965 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 10936) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN D14473) |
| Enumeration Date | 2020-08-30 |
| Last Update Date | 2024-06-16 |