| NPI | 1174318315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS045154) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN10000825) |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-06-09 |