| NPI | 1588300768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61950) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2021048523) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2022-06-24 |