| NPI | 1790241891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13968) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34848) |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2024-09-27 |