| NPI | 1689871246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN123509) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 053166) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2024-09-16 |