| NPI | 1013466630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011705) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 100831) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2023-06-13 |