| NPI | 1205483278 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11352) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1002184) |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2020-11-11 |