| NPI | 1356579718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: GA DN014467) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037892) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2013-01-24 |