| NPI | 1871162404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600928) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 1871162404) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2023-02-15 |