| NPI | 1205202397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 7270) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3896-16) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2021-10-28 |