| NPI | 1063982957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS0000010853) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 4185-21) |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2022-11-03 |