| NPI | 1275906059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2023046336) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61230) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2024-01-19 |