| NPI | 1508542762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2023024877) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 28072) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2026-05-18 |