| NPI | 1083790356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: PR 3199) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MD 11172) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2023-08-08 |