| NPI | 1376066530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011612) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 11154) |
| 1223G0001X Dentist, General Practice (Licence: LA 6807) | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-12-13 |