| NPI | 1508435058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN26687) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10632) |
| Enumeration Date | 2021-06-20 |
| Last Update Date | 2024-05-09 |