| NPI | 1679142160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 1609389113) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12289) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2023-06-05 |