| NPI | 1639442916 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 122300000X Dentist (Licence: TN 7823)  | 
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: TN 442866)  | 
| Enumeration Date | 2012-02-16 | 
| Last Update Date | 2012-02-16 |