| NPI | 1073779211 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014232) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16121) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2016-05-03 |