| NPI | 1679530521 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 12471) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 0112) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2023-03-07 |