| NPI | 1366916652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NC 12771) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 1865) |
| Enumeration Date | 2019-01-20 |
| Last Update Date | 2023-08-05 |