| NPI | 1235510421 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 9192) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA DDS-09192) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2024-10-14 |