| NPI | 1104591023 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN122370) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12455) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2023-02-27 |