| NPI | 1285824565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08503) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA dn013956) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2023-04-20 |