| NPI | 1790155141 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000010122) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 12984) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2022-10-20 |