| NPI | 1275141095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2023013425) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61643) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2023-06-13 |