| NPI | 1235682881 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10712) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9850562-9922) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2019-10-04 |