| NPI | 1730958273 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D012623) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00205834) |
| Enumeration Date | 2023-12-26 |
| Last Update Date | 2025-11-14 |