| NPI | 1437691904 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: LA 7016) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA S865) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2023-10-23 |