| NPI | 1457767212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D10414) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2014019552) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2021-01-05 |