| NPI | 1992216345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11770) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D13921) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2021-02-10 |