| NPI | 1164037800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN016128) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN016128-T) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2022-08-23 |