| NPI | 1225522972 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 13636315-9926) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61021787) |
| 122300000X Dentist (Licence: IL 019031579) | |
| Enumeration Date | 2018-06-17 |
| Last Update Date | 2024-02-05 |