| NPI | 1356444152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014927) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 8060) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2015-03-03 |