| NPI | 1043410293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN 013790) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18400) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2016-05-20 |