| NPI | 1104302124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38304) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 14131) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1001884) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2025-10-02 |