| NPI | 1750579512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1394) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 23263) |
| 1223G0001X Dentist, General Practice (Licence: TX 23263) | |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2020-10-27 |