| NPI | 1760095434 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN28666) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600690) |
| 122300000X Dentist (Licence: MN D14462) | |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2023-11-01 |