| NPI | 1205562337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 1205562337) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601495) |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2022-11-15 |