| NPI | 1629592456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61517) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101759) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2021-07-08 |