| NPI | 1215259700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 015325) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28333) |
| 122300000X Dentist (Licence: IL 019027951) | |
| 122300000X Dentist (Licence: KS 60736) | |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2019-07-22 |