NPI | 1073040143 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11663) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9175) |
Enumeration Date | 2017-05-18 |
Last Update Date | 2020-01-15 |