| NPI | 1831500305 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8430) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 4098) |
| Enumeration Date | 2014-05-18 |
| Last Update Date | 2020-10-22 |