| NPI | 1063760882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 10867) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414640) |
| 1223G0001X Dentist General Practice (Licence: NC 056122-1) | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2023-06-22 |