| NPI | 1811493588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 11048) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 82194001) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2019-07-03 |