| NPI | 1104483502 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1002227) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 17345) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1858305) | |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2021-09-08 |