| NPI | 1619394194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: FL DN20535) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20535) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2019-01-05 |