| NPI | 1902050594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD3080) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011709A) |
| Enumeration Date | 2008-11-09 |
| Last Update Date | 2015-05-13 |