| NPI | 1770817231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2009029162) |
| Additional Taxonomies | 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: KS 60948) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2019-09-03 |