| NPI | 1417573312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0411000075) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 11867) |
| 125Q00000X Oral Medicine (Licence: VA 0411000075) | |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2025-04-09 |