| NPI | 1174196422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2022018454) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033173) |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2022-07-01 |