| NPI | 1942841788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN25739) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858501) |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2021-04-19 |