| 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 |