| NPI | 1255783627 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2021011959) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK F009) |
| 1223G0001X Dentist, General Practice (Licence: ME FDN13) | |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2022-04-06 |