| NPI | 1376521401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN012602) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 18172) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2011-03-02 |