| NPI | 1528635612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6001033-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001033-15) |
| 122300000X Dentist (Licence: KY 10584) | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2022-08-04 |