| NPI | 1548517576 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015773) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056853) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2019-01-07 |