| NPI | 1154583672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013849) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019880) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2009-11-05 |