| NPI | 1194138503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 00000000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 4123-20) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2020-09-16 |