| NPI | 1508434515 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401419296) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2021021138) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2025-04-15 |