| NPI | 1760604144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401006862) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 2022018399) |
| 1223G0001X Dentist General Practice (Licence: MO 2022018399) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2025-04-24 |