| NPI | 1013267467 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8598) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029190) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2022-10-17 |