| NPI | 1720022304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014931) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3174) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-06-16 |