| NPI | 1659866846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416128) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN2000358) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2025-10-28 |