| NPI | 1164801239 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001074 - 15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 1001074) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2020-09-17 |