| NPI | 1053099507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123999) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 8017) |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-10-07 |