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 |