| NPI | 1639662174 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN23412) | 
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN23412) | 
| Enumeration Date | 2018-06-10 | 
| Last Update Date | 2023-12-07 |