| NPI | 1508212333 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL 1518) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: FL DN23387) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2020-03-24 |