| NPI | 1790430189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D011685) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0134081) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2023-03-30 |