| NPI | 1114156643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN012409) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8157) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2009-07-06 |