| NPI | 1396182952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2011016314) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2011016314) |
| 122300000X Dentist (Licence: KS 60960) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2019-04-16 |