| NPI | 1639742562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2024003609) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033336) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2024-02-13 |