| NPI | 1760112197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 39299) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61907) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2023-02-28 |