| NPI | 1164207981 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 14021) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D14993) |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2024-11-25 |