| NPI | 1114379898 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8760) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 22044) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2019-06-18 |