| NPI | 1245864859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 12112) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9562) |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2022-09-15 |