| NPI | 1881960102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: MO 2011015349) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: KS 61101) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2016-04-22 |