| NPI | 1871275172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 7969) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2026011892) |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2026-03-24 |