| NPI | 1417574757 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001367-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858681) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2024-04-11 |