| NPI | 1740954072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN122566) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 12371717-9921) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2023-03-13 |