| NPI | 1336719830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 42030) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 4223-21) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2025-10-01 |