| NPI | 1104207067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-09825) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7231) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2023-01-11 |