| 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 |