| NPI | 1174371546 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 223233500) |
| Additional Taxonomies | 126900000X Dental Laboratory Technician (Licence: UT 223233500) |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-05-09 |