| NPI | 1104171883 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 9683) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 9518) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2021-12-07 |