| NPI | 1679980767 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414493) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414493) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2022-08-02 |