| NPI | 1659748010 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2022047123) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2015029618) |
| 1223G0001X Dentist, General Practice (Licence: HI 2736) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2023-02-14 |