| NPI | 1669030979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 126800000X Dental Assistant |
| Additional Taxonomies | 122300000X Dentist (Licence: ZZ 1143824335) |
| 126900000X Dental Laboratory Technician | |
| Enumeration Date | 2019-06-01 |
| Last Update Date | 2019-06-01 |