| NPI | 1679945455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015619) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 0586931) |
| 1223G0001X Dentist, General Practice (Licence: SC DGD9065) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2018-08-14 |