| NPI | 1184771248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015111) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50092) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2016-01-10 |