| NPI | 1285626598 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015502) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9074) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22D102185700) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2019-01-15 |