| NPI | 1396361887 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD5350) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24965) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2020-10-09 |