| NPI | 1548040728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: MI 2952000840) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2952000840) |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2026-03-23 |