| NPI | 1447788724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: KS 61390) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61390) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2019-01-24 |