| NPI | 1548501851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN015190) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414127) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2019-11-13 |