| NPI | 1972093128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1002497) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416050) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2024-05-08 |