| NPI | 1457737629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2015026615) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61203) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2017-01-16 |