| NPI | 1164716254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014672) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.8081GD) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2020-01-27 |