| NPI | 1104219492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015100) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6590) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2021-10-22 |