| NPI | 1710101621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GA DN013615) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 2739) |
| 122300000X Dentist (Licence: SC 4502) | |
| 1223P0300X Dentist, Periodontics (Licence: TX 25877) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2023-03-28 |