| NPI | 1922636927 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 32814206) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 435135241) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2020-03-27 |