| NPI | 1366809543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61107) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2015041775) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2022-08-14 |