| NPI | 1619358637 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2014023988) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019030156) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2018-11-11 |