| NPI | 1790193126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012153A) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60715475) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2017-03-15 |