| NPI | 1174107478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11791) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09880) |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2023-06-06 |