| NPI | 1619422839 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 14105) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10475) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2026-03-26 |