| NPI | 1689890899 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: MT 1880) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MT 1880) |
| 1223X2210X Dentist Orofacial Pain (Licence: MT 1880) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2022-05-19 |