| NPI | 1629635164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 4396) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 4396) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2022-05-02 |