NPI | 1316505290 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL dn26592) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416521) |
Enumeration Date | 2019-06-05 |
Last Update Date | 2022-01-04 |