| NPI | 1790768851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN123430) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SC 4080) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-07-17 |