| NPI | 1487291886 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2019036502) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 61730) |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2023-11-29 |