| NPI | 1174248058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IA FAC-40215) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: IA FAC-40215) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2022-10-25 |