| NPI | 1497111066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DNO15305) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02620200) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2016-11-16 |