| NPI | 1659636868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 08928) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IA 08928) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2023-01-20 |