| NPI | 1083846554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015301) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 9954) |
| 122300000X Dentist (Licence: MI 2901020853) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2026-06-18 |