| NPI | 1689953960 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN014385) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9101) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2018-01-09 |