| NPI | 1669734356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D008445) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28721) |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2021-09-14 |