| NPI | 1619405636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: NC 14037) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: LA 6755) |
| Enumeration Date | 2017-06-03 |
| Last Update Date | 2025-08-14 |