| NPI | 1922474519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61523) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021571) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2019-04-25 |