| NPI | 1760977326 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 11629594-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 7082) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2023-05-02 |