| NPI | 1124689997 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D12074) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5056) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2026-06-10 |