| NPI | 1235308537 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: NC 12074) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: TN DS004431) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2021-11-28 |