| NPI | 1962191056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61655464) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 064256) |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2025-06-10 |