| NPI | 1861005530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61963) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2020026899) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2022-09-11 |