| NPI | 1265848709 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 30211) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6716) |
| Enumeration Date | 2014-07-04 |
| Last Update Date | 2018-02-20 |