NPI | 1750952792 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MN D14587) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 1002683-15) |
Enumeration Date | 2021-07-09 |
Last Update Date | 2021-11-01 |