| NPI | 1235693706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001142-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416398) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2023-06-22 |