| NPI | 1679143564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2021019518) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2021019518) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2025-01-13 |