| NPI | 1366826265 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 600109815) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2015020287) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2022-11-11 |