| NPI | 1205084944 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 013564) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 0553291) |
| Enumeration Date | 2008-09-07 |
| Last Update Date | 2013-01-17 |