| NPI | 1245630896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 10345) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014865) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2019-07-17 |