| NPI | 1669092540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123149) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 061922) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2023-09-06 |