| NPI | 1093363772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12057) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD LL860) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2020-09-21 |