| NPI | 1972990695 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-4751) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 10936825-9922) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2019-01-03 |