| NPI | 1679967467 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123403) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3975-17) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2024-12-23 |