| NPI | 1124258835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013901) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9236) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2016-01-26 |