| NPI | 1003879255 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23195) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050970) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2021-01-29 |