| NPI | 1154975076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11096) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011970) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2026-07-03 |