| NPI | 1972100964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7452) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858839) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1858839) | |
| Enumeration Date | 2020-10-03 |
| Last Update Date | 2022-09-08 |