| NPI | 1811566359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD9955) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122882) |
| Enumeration Date | 2021-06-20 |
| Last Update Date | 2022-09-23 |