| NPI | 1801247002 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D11041) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401415295) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2019-10-16 |