| NPI | 1174922090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011156) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29660) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2021-08-05 |