| NPI | 1881180974 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OK 81) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6853) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2021-02-09 |