| NPI | 1720770712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 13766) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL dn28456) |
| 122300000X Dentist (Licence: KY 10947) | |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2025-08-07 |