| NPI | 1518538503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN123012) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043060) |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2023-11-21 |