| NPI | 1730799719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D012410) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 062083) |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2025-04-24 |