| NPI | 1255731246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 12569) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 20922) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2023-07-08 |