| NPI | 1659763811 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31644) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009137) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2025-11-17 |