| NPI | 1275805129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA DN015360) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 27695) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2019-01-31 |