| NPI | 1720165558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN013175) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 672) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2009-11-11 |