| NPI | 1366965337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9798) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 10814) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2021-08-10 |