| NPI | 1417686361 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 14069) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 12874250) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2025-04-30 |