| NPI | 1962073577 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1002654-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09919) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2021-07-25 |