| NPI | 1083308373 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 600167115) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN D14963) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2024-10-15 |