| NPI | 1568045805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN25556) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1860049) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2026-07-10 |