| NPI | 1790415834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 4337-22) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 11932) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-08-13 |