| NPI | 1912355314 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001755-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT DEN-DEN-LIC-11460) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2019-04-26 |