| NPI | 1801643895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: PR 003460) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL 26578) |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2025-04-10 |