| NPI | 1740413228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: VA 0401413484) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ DI24203) |
| 122300000X Dentist (Licence: GA DN014235) | |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2025-05-13 |