| NPI | 1710570692 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 14038) | 
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D011272) | 
| Enumeration Date | 2021-02-11 | 
| Last Update Date | 2025-02-13 |