| NPI | 1700085107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 21399) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21692) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MT 21399) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2023-07-20 |