| NPI | 1255690939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 9485) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ND 2141) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2020-08-13 |