| NPI | 1659924843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1002152-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ND 2401) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2020-09-01 |