| NPI | 1710319298 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 134667) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 62770) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2023-02-06 |