| NPI | 1053930214 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 11829182) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11829182-9921) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2023-08-07 |