| NPI | 1124382866 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12618) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29313) |
| 1223G0001X Dentist, General Practice (Licence: FL DN20973) | |
| 1223G0001X Dentist, General Practice (Licence: GA DN014419) | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2022-02-24 |