| NPI | 1083176275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN122281) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC DGD.9664) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2021-07-22 |