| NPI | 1104335348 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 12124415-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 12124415-9921) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2024-08-09 |