| NPI | 1760369987 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401419672) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: PA RFD000080) |
| Enumeration Date | 2025-08-19 |
| Last Update Date | 2025-11-11 |