| NPI | 1922428986 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN ds0000009759) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 09147) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2018-04-06 |