| NPI | 1558418699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 11087) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 16775) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-06-17 |