| NPI | 1740661925 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC SC8864) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014973) |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2019-01-04 |