| NPI | 1194760785 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DNO11877) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9154) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2007-10-12 |