| NPI | 1396397121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2023016438) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7222) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2023-08-23 |