| NPI | 1891122115 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9609) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401419533) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2025-06-20 |