| NPI | 1184062226 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2020011221) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60457750) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2020-08-03 |