| NPI | 1932802741 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 125Q00000X Oral Medicine (Licence: NC 13630) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 13630) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-07-02 |