| NPI | 1538473285 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014998) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 046912) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2020-09-08 |