| NPI | 1861177834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN31036) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044144) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2026-01-12 |