| NPI | 1720683428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 12967) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 12967) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2021-11-02 |