| NPI | 1831716448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: IA 09793) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: IA 09793) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2023-07-05 |