| NPI | 1275985889 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 20200066283) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61435) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2021-12-10 |